Sentinel Lymph Node Identification Using Hysteroscopy in Patients with Endometrial Cancer

Česká verzia

Authors: R. Feranec ¹; L. Mouková ¹; J. Staníček ²; L. Štefániková ²; J. Chovanec ¹
Authors place of work: Oddělení gynekologické onkologie, Masarykův onkologický ústav, Brno ¹; Oddělení nukleární medicíny, Masarykův onkologický ústav, Brno ²
Published in the journal: Klin Onkol 2010; 23(2): 92-98
Category: Original Articles

Summary

Backgrounds:
Endometrial carcinoma is the most frequent gynecologic malignancy. The incidence is 30 : 100,000 with an increasing tendency. The main therapeutic modality remains radical surgery. The purpose of the study is to evaluate the feasibility of sentinel lymph node (SLN) detection in endometrial cancer using hysteroscopic administration of radiocolloid and the combination of preoperative lymphoscintigraphy with intraoperative gamma‑ detection probe examination.

Patients and Methods:
From May 2006 to January 2009, 99mTc‑ labelled nanocolloid (100 MBq) was administered preoperatively in 21 patients with endometrial cancer. On the day of surgery, radiocolloid together with blue dye was injected via 20- gauge needle under the endometrium using hysteroscopy. Lymphoscintigraphy was performed in all patients after 60 minutes. Therapeutic surgery followed the tracer administration 2 hours later in extensity of abdominal hysterectomy, bilateral salpingo‑ oophorectomy, peritoneal wash, pelvic lymphadenectomy and in patients with positive high‑risk prognostic factors of paraaortic lymphadenectomy. SLN was located by use of gamma‑ detecting probe intraoperatively.

Results:
At least one SLN was detected in 17 of 21 (81%) patients included in the study. The mean number of detected SLNs was 2 (range 1– 5). 8 of 17 (47%) patients had radioactive nodes only in the paraaortic area. Synchronic appearance of SLNs in the pelvic and paraaortic areas was detected in 1 of 17 (6%) cases. Overall, in 4 of 9 (44%) cases of sentinel lymph node localization in the paraaortic area the SLNs were detected at the level above the inferior mesenteric artery. The metastatic involvement of 3 sentinel lymph nodes was detected in one patient (3 lymph nodes with micrometastases). All the remaining lymph nodes not labelled as SLNs were histologically negative in this case. The sensitivity and specificity for SLN metastases detection was 100%.

Conclusion:
SLN detection in endometrial cancer appears to be a promising method with the potential to reduce unnecessary surgery radicality and to clarify staging. The utilization of hysteroscopic application of radiocolloid respects the anatomical consequences and natural lymphatic drainage of the endometrium. The combination of pre‑operative lymphoscintigraphy and intra‑ operative detection using a handheld gamma probe can be beneficial.

Key words:
carcinoma – endometrium – sentinel lymph node – hysteroscopy

Zdroje

1. Feranec R, Otevrel P, Frgala T et al. Lymphatic Mapping and Sentinel Lymph Node Biopsy in Patients with Endometrial Cancer. Klin Onkol 2007; 20(2): 199– 204. Review. Czech.

2. Niikura H, Okamura C, Utsunomiya H et al. Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol 2004; 92(2): 669– 674.

3. Burke TW, Levenback C, Tornos C et al. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high‑risk endometrial cancer: results of a pilot study. Gynecol Oncol 1996; 62(2): 169– 173.

4. Holub Z, Kliment L, Lukac J et al. Laparoscopically‑ assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results. Eur J Gynaecol Oncol 2001; 22(2): 118– 121.

5. Holub Z, Jabor A, Kliment L. Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer: a pilot study. Eur J Gynaecol Oncol 2002; 23(1): 53– 57.

6. Holub Z, Jabor A, Lukac J et al. Laparoscopic detection of sentinel lymph nodes using blue dye in women with cervical and endometrial cancer. Med Sci Monit 2004; 10(10): 587– 591.

7. Pelosi E, Arena V, Baudino B et al. Pre‑operative lymphatic mapping and intra‑ operative sentinel lymph node detection in early stage endometrial cancer. Nucl Med Commun 2003; 24(9): 971– 975.

8. Barranger E, Fay S, Cortez A et al. Value of sentinel node biopsy in uterine. Cancers Gynecol Obstet Fertil 2004; 32(9): 694– 702.

9. Fersis N, Gruber I, Relakis K et al. Sentinel node identification and intraoperative lymphatic mapping. First results of a pilot study in patients with endometrial cancer. Eur J Gynaecol Oncol 2004; 25(3): 339– 342.

10. Raspagliesi F, Ditto A, Kusamura S et al. Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a feasibility study. Am J Obstet Gynecol 2004; 191(2): 435– 439.

11. Pilka R, Kudela M, Koranda P et al. Possible approaches to sentinel node detection in women with endometrial cacer: Pilot study. Ceska Gynekol 2001; 66(6): 427– 431. Czech.

12. Maccauro M, Lucignani G, Aliberti G et al. Sentinel lymph node detection following the hysteroscopic peritumoural injection of (99m)Tc‑ labelled albumin nanocolloid in endometrial cancer. Eur J Nucl Med Mol Imaging 2005; 32(5): 569– 574.

13. Dzvincuk P, Pilka R, Kudela M et al. Sentinel lymph node detection using 99mTc‑ nanocolloid in endometrial cancer. Ceska Gynekol 2006; 71(3): 231– 236. Czech.

14. Frumovitz M, Bodurka DC, Broaddus RR et al. Lymphatic mapping and sentinel node biopsy in woman with high‑risk endometrial cancer. Gynecol Oncol 2007; 104(1): 100– 103.

15. Lopes LA, Nicolau SM, Baracat FF et al. Sentinel lymph node in endometrial cancer. Int J Gynecol Cancer 2007t; 17(5): 1113– 1117.

16. Delaloye JF, Pampallona S, Chardonnens E et al. Intraoperative lymphatic mapping and sentinel node biopsy using hysteroscopy in patients with endometrial cancer. Gynecol Oncol 2007l; 106(1): 89– 93.

17. Perrone AM, Casadio P, Formelli G et al. Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol Oncol 2009; 113(2): 296– 297.

18. Ballester M, Rouzier R, Coutant C et al. Limits of lymphoscintigraphy for sentinel node biopsy in women with endometrial cancer. Gynecol Oncol 2009; 112(2): 348– 352.

19. Robova H, Charvat M, Strnad P et al. Lymphatic mapping in endometrial cancer: comparison of hysteroscopic and subserosal injection and the distribution of sentinel lymph nodes. Int J Gynecol Cancer 2009; 19(3): 391– 394.

20. Abu‑ Rustum NR, Khoury‑ Collado F, Pandit‑ Taskar N et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol 2009; 113(2): 163– 169.